Assignment: Assessing and Treating Pediatric Clients With Mood Disorder

Assignment: Assessing and Treating Pediatric Clients With Mood Disorder

Assignment: Assessing and Treating Pediatric Clients With Mood Disorder

Mood disorders can impact every facet of a child’s life, making the most basic activities difficult for clients and their families. This was the case for 13-year-old Kara, who was struggling at home and at school. For more than 8 years, Kara suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues. As a psychiatric mental health nurse practitioner working with pediatric clients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies.

This week, as you examine antidepressant therapies, you explore the assessment and treatment of pediatric clients with mood disorders. You also consider ethical and legal implications of these therapies.

Assignment: Assessing and Treating Pediatric Clients With Mood Disorder

When pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.

Note: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.

Learning Objectives

Students will:

• Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clients
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapy
• Evaluate efficacy of treatment plans
• Analyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clients

Assignment: Assessing and Treating Pediatric Clients With Mood Disorders

When pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.

Note: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.

Learning Objectives

Students will:

• Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clients
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapy
• Evaluate efficacy of treatment plans
• Analyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clients

Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

• At each decision point stop to complete the following:
  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
  • Decision #2
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

The assessing and Treating Pediatric Clients with Mood Disorders Introduction Depression is the most common mental disorder for young people, and it is associated with educational underachievement, self-harm, and suicidality. The depression rate among children this day is so disturbing. The effect of depression is devastating since it leads to a variety of physical and emotionally problems. 1 Depression can reduce the child ability to function at academically (American Psychiatric Association, 2018).

We can categorize depression in children into two types, the 1st is major depression in this type of depression the child will be in depression for less than a month and the child might experience it again sometime in life. Dysthymia depression is a less form of severe chronic depression that last for two years in total (American Psychological Association, 2016). This is the most serious and considered the leading cause of suicide death, and disability in adolescent in this age group (WHO, 2014) Selective serotonin reuptake inhibitors (SSRIs) is antidepressant and helps children and adolescent to get back into a stable mood from mood disorder. It is important to monitor children at a closely at the first four weeks of administering this medication, this help identify a change in behavior.Some sign to watch for include sleeplessness, withdrawal from social gathering or unnecessary agitation (Anxiety and Depression Association of America, 2016).

2 This paper is my opportunity to examine An African American Child Suffering From Depression. What is, what treatment options are available and the effects of the stigma of MDD on the African American child and family. 3 African Americans are no different when its comes to prevalence of mental health conditions when compared to the rest of the population. Poverty level affects mental health status. 1 African Americans living below the poverty level, as compared to those over twice the poverty level, are 3 times more likely to report psychological distress Decision Selected # 1 I will choose Zoloft 25mg as my first choice of medication Reason for Selection: I have work with a diverse group of patient in including African American in the course of my experience working in children in hospitals unit several years .I have to start with Zoloft 25mg. most provider I worked with will not want to give much medication because of this age group. 1 Zoloft is considered “off-label meaning it is not approve by the Food and Drug Administration (FDA) to treat depression in children and adolescents; randomized controlled trials (RCTs) approved it because the benefits. 1 According to the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP, 2016), Zoloft is safes and is the best option to treat mood disorders in children in this age group.

Expected Results In the 1st two weeks of therapy, we expect some progress as the child is expected to exhibit that there is evident in physical symptoms like increase in appetite, and sleep. We should also expected increase is the child concentration within a month, and an increase peer group interactions, and expected to withdraw less from peers. If all things work as expected and absent of adverse reaction, will continue with the treatment (IACAPAP, 2016), Differences between Expected outcome and Actual outcome After two weeks, he patient is expected to come back for a visit to be evaluated for the medication effectiveness. If the goal of the medication is met, and there is no symptom for side effect, then the medication and the dosage will remain the same until the next appointment. If expected result is not not met and there is no sign or symptom of adverse effect, the medication will be increased to Zoloft 50mg. I have to be aware that, the difference between the expected outcome and actual outcome is the dosage being low or higher than the needed therapeutic level for the patient (National Alliance on Mental Illness, 2017).

Decision Selected # 2 Reason for Selection: Decision one within four weeks follow-up, my expected outcome has not been achieved. The child is still presented with depressive symptoms. The patient and parent denies any side effect of Zoloft., but the child is still showing signs of major depressive disorder (MDD). I will increase Zoloft to 50mg to attain medication therapeutic effect. 1 This will be done after addressing the effect with patient and family and documented after discussing the risks, benefits and education about MDD and the planned of treatment by increasing the dosage, goals for this client remain the same. We will continue to monitor any side effects, like suicidality risk (National Alliance on Mental Illness, 2017).

Expected Results My client should be able to verbalize some positive changes like reduce in depressive symptoms of Zoloft 50mg. If the higher dose help in reducing depression with no side effect of medication. 1 I will now encourage patient and reassure parents.This improvement should include participating in groups, peers interaction , improve sleep, appetite and academic improvement (American Psychiatric Association, 2018).

4 Differences between Expected outcome and Actual outcome There should be appositive noticeable change with therapeutic of Zoloft 50mg, a decrease in depression symptoms with and no adverse reaction that indicate otherwise that patient is tolerating the therapeutic medication adjustment well. 1 Since at this level, there is no difference between the expected result and the actual result therefore the patient will continue with the Zoloft 50mg. Patient should be monitoring continue, and the next schedule appointment.

Decision Point Three Maintain current dose of Zoloft 50mg orally daily Reason for Selection When the patient shows improvement, we have to keep schedule medication especially when there is no side effect of medication. My patient has shown great degree of improvement, and there is no side effect to this patient with the dose of Zoloft 50mg. 1 The monitoring of the side effect will include suicidal thought (National Alliance on Mental Illness, 2017).

Expected Results Treatment of depression, and monitoring is a continues process. 1Patient improvement should daily, and the signs of depression will be eliminated gradually with dosage of Zoloft 50mg. Patient peer interaction, sleep, appetite, should gradually improve.

Differences between Expected Results and Actual Results Choosing Zoloft 50mg on my African American child patient seems to be working, with no problem. Patient is responding well to therapy. I will continue patient with current dose. With this gradual improvement, I have no reasons to change medication or dosage. I will schedule an appointment and the dose might be increase if depression increases. 1 The expected result would be in treating any side effect to the medication so that maximum therapeutic effects can be achieved. The actual result is that there is an achievement in medication therapeutic effect that is needed by the patient (National Alliance on Mental Illness, 2017).

5 Ethical Considerations Suicidal ideation or behavior is only one reason for which close monitoring is important for children started on antidepressant therapy (Mitchell et al., 2014). Therefore, providers who are considering the use of antidepressants in children, adolescents, and young adults must first balance the risk of suicidality with the clinical need for an antidepressant (Mitchell et al., 2014). 1 The ethic consideration can be classified as an accumulation of reasoning and principle of treatment of depression.The suicidal tendency in the used of antidepressant medication has led the FDA to require that all antidepressant medicine should be labeled by pharmaceutical companies with the caution of suicidal on the label (Sondheimer, 2010). Any child that is below the age of 18years old cannot take decision on depression treatment without the parent approval according to FDA regulation (Sondheimer,2010). Therefore, it is paramount to educate the parent of the treatment given to the child as well the consent of the parent.In case of danger, the consent advice of the parent may be ignored (Sondheimer, 2010).The Zoloft is “off-label” so a greater precaution and parent approval needs to be obtain before dispensing.

6 This lack of knowledge leads many to believe that a mental health condition is a personal weakness or some sort of punishment from God. Many African Americans also have trouble recognizing the signs and symptoms of mental health conditions, leading to underestimating the effects and impact of mental health conditions. 3 Faith and spirituality can help in the recovery process but should not be the only option you pursue. If spirituality is an important part of your life, your spiritual practices can be a strong part of your treatment plan. Your spiritual leaders and faith community can provide support and reduce isolation.

7 Conclusion The FDA advises that doctors prescribe the smallest quantity of pills possible to help reduce the risk of deliberate or accidental overdose. A careful monitoring by parents, caregivers and health care professionals is important for any child or teenager taking an antidepressant for depression or any other condition. 1 Food and Drug Administration (FDA or USFDA) has a rule and regulation set for the treatment of behavioral disorder in children, the guideline which must be follow to the letter (National Alliance on Mental Illness, 2017). Supervising and safe monitoring of the child is very important during therapy (National Alliance on Mental Illness, 2017). 1 The legality guiding the treatment of a child with psychiatric problem has increase because of increase national awareness. As a psychiatric nurse, I strive to increase my knowledge of the legal and ethical implications of prescribing psychotropic medications for children.and adolescents with major depression and anxiety disorders. 3 African Americans are no different when its comes to prevalence of mental health conditions when compared to the rest of the population, depression one of the mental health issues in African American community.

1 References American Psychiatric Association (2018). Practice guideline for the treatment of patients with the major depressive disorder (3rd ed., pp. 152). Arlington (VA): 1 American Psychiatric Association (APA). 2 Retrieved from https://www.guideline.gov/summaries/summary/24158?

1 American Psychological Association. (2016). 1 Psychotropic Medications for Children and Adolescents. Retrieved from:

1 http://www.apa.org/pi/families/resources/child-medications.pdf.

Anxiety and Depression Association of America. (2016). 1 Anxiety and Depression in Children. Retrieved from:https://adaa.org/living-with-anxiety/children/anxiety-and-depression International Association for Child and Adolescent Psychiatry and Allied Professions.

Bennet, N. (2016). 5 Legal and ethical issues related to the prescription of psychiatric medication to children (and teens). Retrieved from https://www.ohsu.edu/xd/health/for-healthcare-professionals/telemedicine-network/for-healthcare-providers/ohsu-echo/upload/Legal-and-Ethic-issues-treating-C-and-A-mental-health-Bennett-N-2016.pdf De Vries, Y. A., De Jonge, P., Kalverdijk, L., Bos, J. H., Schuiling-Veninga, C. C., & Hak, E. (2016). 5 Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose. European Child & Adolescent Psychiatry, 25(11), 1161-1170. Retrieved from https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=4&sid=2505bbce-c8cf-4f53-9c28-70e0106cb774%40sessionmgr120 Department of Human and Health Services. (2013). Antidepressant Medications: 5 Use in Pediatric Patients. Retrieved from https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Pharmacy-Educatio

Mitchell, A. 5 M., Davies, M. A., Cassesse, C., & Curran, R. (2014). 5 Antidepressant Use in Children, Adolescents, and Young Adults: 10 Years After the Food and Drug Administration Black Box Warning. The Journal for Nurse Practitioners, 10(3), 149-156.Retrieved from https://www-sciencedirect-com.ezp.waldenulibrary.org/science/article/pii/S1555415513004856?via%3Dihub Sheridan, D. C., Lin, A., & Zane Horowitz, B. (2017). 5 Suicidal bupropion ingestions in adolescents: increased morbidity compared with other antidepressants. Clinical Toxicology, 1-5. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/15563650.2017.1377839 Stahl, S. M. (2017). 5 Stahl’s essential psychopharmacology: The prescriber’s guide (6th ed.). New York, NY: Cambridge University Press.